Two-dimensional echocardiographic assessment of normal fetal cardiac anatomy

The fetal heart is visualized routinely during the antepartum ultrasound examination. Because of the advent of high-resolution, real-time ultrasound instruments, details of fetal cardiac anatomy can now be defined. Fifty consecutive fetuses were examined in utero to assess the ability of two-dimensional echocardiography to define intracardiac anatomy at various gestational ages. A complete examination required at least three standard echocardiographic views of the heart: four-chamber, short-axis and long-axis views. In 30 of the 50 fetuses studied (60%) only one examination was necessary to obtain this information. Ten patients had a second examination later in gestation that complemented the findings of their first study. In all but two fetuses, detection of all four cardiac chambers and at least one semilunar valve was possible. Mitral-semilunar valve continuity was detected in all. The quality of echocardiographic imaging was enhanced by the fetal occiput posterior position (three views obtained in 83% of the fetuses studied). Breech position did not affect imaging quality. Prior to 30 weeks of gestation, fetal movement hampered analysis of fetal cardiac anatomy in some patients.